Diabetes in pregnancy may lead to impaired lung development and poor respiratory health among infants, according to a new review paper by researchers at the Developmental Origins of Chronic Diseases in Children Network (DEVOTION) in Manitoba.

Together, these studies provide evidence that exposure to diabetes in utero may have adverse effects on an infant’s lung development, including delayed lung maturation and an increased risk for a condition known as respiratory distress syndrome (RDS). RDS is a breathing disorder in which the air sacs (alveoli) in a newborn’s lungs collapse because the production of a substance that coats the alveoli (surfactant) is absent or insufficient.

According to lead author Dr. Meghan Azad, a Research Scientist at the Children’s Hospital Research Institute of Manitoba, a potential mechanism for the association between diabetes in pregnancy and infant RDS is related to high circulating levels of glucose in the diabetic mother.

“From the studies we reviewed, it appears that newborns who were exposed to hyperglycemia in utero may have impaired production of surfactant proteins that are important for proper lung function,” said Dr. Azad, who is also an assistant professor in Pediatrics & Child Health at the University of Manitoba and an investigator with AllerGen’s CHILD Study. “Our review also found that these clinical observations have been confirmed in rodent models of diabetes in pregnancy.”

The research team also observed a positive association between diabetes in pregnancy and childhood asthma—a finding seen in four studies from four countries—and identified this as an interesting area for future research.

Dr. Vernon Dolinsky, an associate professor at the University of Manitoba, was a study co-author. “Long-term studies will be particularly valuable for establishing lifecourse implications of diabetes in pregnancy on lung health,” he said. “To our knowledge, there is no study that has investigated these associations beyond early adolescence.”

Dr. Dolinsky is leading a Canadian Institutes of Health Research (CIHR) study about diabetes in pregnancy using samples from the CHILD Study.